Provider Demographics
NPI:1316935679
Name:WEYANDT, LINDA JANE
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JANE
Last Name:WEYANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ANCHOR BAY CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8179
Mailing Address - Country:US
Mailing Address - Phone:713-410-1555
Mailing Address - Fax:610-471-2528
Practice Address - Street 1:2011 ANCHOR BAY CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8179
Practice Address - Country:US
Practice Address - Phone:713-410-1555
Practice Address - Fax:610-471-2528
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM00588367500000X
TX461117367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty